Queen Mary and Westfield College London University PhD Thesis ...

ceration. I will proceed to discuss patients' geographical provenance, locating the hospital in the
catchment areas that it served, and setting settlement information obtainable from the hospital
archives in the context of vagrancy and lunacy laws, and in the broader context of parochial
relief. This analysis shall underline the difficulties of authorities in establishing and enforcing
obligations of settlement, and the extra difficulties entailed by the expense of maintaining the
insane and by their particular tendency to wander. It shall, also, stress the general acceptance
of a responsibility to cater for the poor insane, and the legal and administrative resources at the
disposal of the hospital and other authorities to compel the meeting of these obligations. The
ensuing section will examine more closely the gradual evolution of diagnostic criteria governing
the reception of patients at Bethlem, focusing in particular on the ambiguities in the hospital's
efforts to distinguish between suitable and unsuitable 'objects of Charity', and on the increas-
ing discrimination exercised by the hospital board and medical officers in this respect. While
medical certification was not introduced as a requirement for confinement in private madhouses
until the Act of 1774, certification by the Bethlem Physician had been a condition of patients'
admission and discharge at the hospital since the 1650s and 60s. While I shall go on to empha-
sise how much Betlilem's provision for the insane was prioritised towards cases designated as
'dangerous', the intensity of the hospital's commitment to short-stay, 'curable' cases, shall also
be demonstrated. The next section will analyse at some length what the 'danger' of the insane
actually signified for contemporaries, delineating inier alia how the insane tended to come into
the situations of conflict which precipitated their committal; how liable were contraventions of
the hierarchical order, whether of families, localities or wider society, to be deemed as threaten-
ing and irrational; and how profoundly the process of referral and incarceration was arbitrated
by the prevailing social and political order. I shall also trace significant areas of tolerance for
the 'unruliness' of the insane. There follows a brief discussion of religious dimensions in the
committal and maintenance of patients at Bethlern; the gradual isolation of the insane from the
more positive associations of divine intervention and inspiration, and the dynamics behind the
mounting influx of religious 'enthusiasts' into the hospital's wards over the course of the eigh-
teenth century. Consistently, during this period, the administrators and promoters of Bethlem
claimed a cure-rate of over , and my final three sections assess more systematically the rather
grim reality of the hospital's record behind the rhetoric of cure. An examination of the after-life
of patients as derivable from parish records will evince just how limited a service Bethlem was
performing, in therapeutic terms, for its pauper clients, and how rarely poor parishioners dis-
charged or removed from the hospital can be said to have been fully recovered, or even, to have
been capable of resuming their former lives. On the other hand, it will also be maintained that,
given the inadequacies, paucity and expense, of alternative provision, Bethlem was performing
no mean service to localities in offering affordable provision for difficult and alienated individu-
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